Biomedical subjects
Publications and source records attributed to H R Guly.
Traumatic herniae are uncommon. We describe two patients with traumatic herniae and review the literature. Operative treatment may be early or late. It is mandatory that traumatic herniae be differentiated from hematomata. Diagnosis is usually clinical but X-rays including barium studies, may be useful.
We describe a case of pisotriquetral arthritis associated with ulnar nerve paraesthesiae. We briefly review the literature and discuss the aetiology of this particular case.
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OBJECTIVE: To report the outcomes of patients with a cardiac arrest occurring in an accident and emergency department and discuss whether this would be an appropriate measure of performance of the department. DESIGN: A 6-year retrospective study of cardiac arrests occurring within the accident and emergency department at a single hospital. SETTING: A district general hospital accident and emergency department in the period 1991-1997. OUTCOME MEASURES: Survival to leave the emergency department, survival to leave hospital. RESULTS: There were 77 cardiac arrests occurring within the department, and of these 42 (55%) survived to be admitted to hospital. Forty-two arrests involved a rhythm of VT/VF with 81% of these arrests surviving to be admitted. Thirty-five patients had other cardiac rhythms of whom 23% survived to admission. Primarily cardiac causes of arrest occurred in 52 patients with a survival rate of 60%. Overall 33 patients (43%) survived to be discharged from hospital. CONCLUSION: Survival from cardiac arrest is a useful measure of performance of an accident and emergency department. It is a condition that has definite outcomes, and is easily auditable. Figures can be compared between departments by comparing cases with the same aetiology or arrest rhythm thus reducing the influence of cases with a poorer outcome. This would provide an additional indicator for comparison of departments other than those currently used. A national database of outcome of cardiac arrests could be created to allow valid comparisons between departments.
Every year 11 million people, or one in five of the population, attend A & E departments for a wide variety of problems. The specialty of A & E has therefore enormous scope for influencing health not only in its primary role of treating trauma and acute illness but also because the number of patients seen gives scope for opportunistic screening and health promotion. This was the theme at a conference at the Royal College of Physicians on 14 and 15 December 1993; it was also the occasion of the first general meeting of the newly created intercollegiate Faculty of Accident and Emergency Medicine.